The present invention relates to electronic information tracking methods for use in the medical field and more particularly to a method and system for tracking, verifying and automatically updating medical procedures performed on patients.
For the purposes of this explanation, any medical procedure, diagnostic procedure, therapeutic procedure or administration of medicine will be referred to hereinafter as a medical event and any event prescribed by a physician will be referred to as a prescribed event. In addition, hereinafter, unless used in conjunction with diagnosing a medical problem or prescribing a treatment for a medical problem, where the term "physician" is used, any other term (e.g. nurse, physicians assistant, facility personnel, etc.) used to identify a person working at a health care facility to perform or administer a medical event could be substituted.
Clearly, one of the most important concerns for any medical facility is that medical events be correctly prescribed. In the case of a medicine, this means that given a set of factors including prior medical history (e.g. medical and diagnostic procedures, currently ingested medicines, past addictions, etc.), current conditions (e.g. age, allergies, addictions, etc.) and current symptoms, the correct medicine be chosen for administration at the correct time. In the case of a procedure, this means that, given the factors identified above, the correct procedure be chosen for performance at the correct time.
To ensure that correct procedures and medications are prescribed, only trained physicians (and in some cases physician assistants) are allowed to prescribe all but the least invasive medical events. It is assumed that medical training of these individuals is sufficient to essentially eliminate the possibility of incorrect diagnosis and mis-prescription.
Years ago correct diagnosis and a suitable prescription of medical events were relatively simple as the number of known medical problems, their symptoms and suitable cures were limited. Diagnosis and prescription were also made easier by the fact that often a doctor would treat a patient throughout the patient's life and thus had an intimate knowledge about the patient's medical history, allergies, etc.
However, in today's medical environment, proper diagnosis and suitable prescription of medicine and procedures is a much more arduous task for many reasons. First, only very rarely will a person have a single doctor throughout most or his or her life. People often relocate to different areas within the country for various reasons. In addition, many physicians relocate during the course of a career making it difficult to maintain physician-patient relationships. Moreover, even where neither a patient nor a physician physically relocates, a patient may be forced to change physicians for other reasons such as a change in insurance or a job change. Furthermore, many doctors specialize in only one area of medicine and therefore patients are often treated by many different doctors to address different symptoms. In these cases, physicians are no longer intimately aware of medical histories and correct diagnosis is therefore more difficult.
Second, literally hundreds of patients are examined and treated on a daily basis in large modern medical facilities, each doctor or nurse interacting with as many as twenty or more patients within a single day. With such high traffic it is very rare for a physician to delve deeply into a patient's medical history to identify other than a handful of symptoms prior to diagnosis and prescription of a treatment. While many diagnosis and prescriptions which are based on the handful of known symptoms might be correct despite medical histories, it is clearly possible that some of the diagnosis and prescriptions might be incorrect in light of medical histories including allergies, addictions, previous medical events, etc.
Third, modern research has lead to the discovery of a plethora of previously unknown medical conditions and medical problems, a huge number of known symptoms for each condition or problem and in some cases, a large number of different possible cures, each of which might have several different side effects and each of which interact with other medicines and procedures in different manners. Given this minefield of considerations, it is now more difficult than ever to diagnose problems and prescribe correct medicines and procedures.
Tools have been developed to help physicians diagnose problems and prescribe correct medicines and procedures. For example, reference books which list, among other things, symptoms, cures, side effects and how a cure will interact with other types of medicines and procedures can be consulted prior to diagnosis and prescription. This same information has also been provided in computer searchable form accessible by a physician or a nurse to aid diagnosis and prescription. An example of a computer aided diagnostic system which could be used by a physician or could also be used by a patient is described in U.S. Pat. No. 5,660,176 entitled Computerized Medical Diagnostic And Treatment Advice System which issued on Aug. 26, 1997. While reference books and computers can be useful diagnostic and prescription tools when employed, these tools are seldom used for a number of reasons.
First, because most doctors have to examine many (e.g. 20 or more) patients each day, doctors only have a short time (e.g. 15 to 20 minutes) with each patient. During this time, a doctor usually only identifies a handful (e.g. 3 to 5) of symptoms and then prescribes a treatment. Simply put, time does not allow most physicians to consult an external information source.
Second, psychologically many patients are uncomfortable with a physician who consults a reference to diagnose a condition and prescribe a treatment. Such consultation can be construed as a sign of inexperience. For this reason, many doctors are uncomfortable accessing a reference in front of a patient and therefore will not access a reference except for in extremely complex cases.
After a problem has been diagnosed and one or more medical events have been prescribed, another extremely important concern for any medical facility is that the correct medical event be performed. If incorrect events are performed, a patient's condition can further deteriorate and, in some cases, can lead to a patient's premature demise.
For example, injury can result from over medication where a prescribed medicine is administered in an unprescribed excessive dose or if a prescribed dose is administered twice, once by a first physician and second by another physician unaware of the first administration. Also, if a physician elects not to administer a dose of prescribed medicine under the erroneous belief that another physician at a facility has already administered the prescribed dose, under medication results which can cause patient discomfort and condition deterioration.
Injury and/or discomfort can result where medicine is administered too soon after a medical procedure or a procedure is performed to soon after a medicine has been administered. Also, injury can result where several procedures are performed within a short time period. For example, excessive radiation from consecutive diagnostic or therapeutic procedures within a short time period can cause illness.
As with diagnosis and prescription, the task of performing prescribed medical events at prescribed times has become relatively difficult in the modern medical environment. Years ago physicians dealt with a relatively small number of patients, medicines and procedures on a daily basis and therefore it was easier to track medical event performance.
Today, each physician interacts with a relatively large number of patients, medicines and procedures on a daily basis and tracking medical event performance is extremely difficult and time consuming. The task of tracking event performance is exacerbated by the fact that many medical facilities are expansive including specialized departments which are spread out throughout the facility, many departments being on different floors or even in different buildings. For example, diagnostic examination, imaging, surgery, recovery, etc., areas are all usually separate and staffed by different personnel. As a patient is moved from one department to another event performance might be delayed or even missed.
In addition, many patients are admitted into a medical facility for a period which is longer than a single shift. Where facility personnel changes during a patient's stay, physicians on the later shift might not be able to determine if a medical event was performed during the earlier shift.
Most medical facilities enforce rigid guidelines designed to ensure that unprescribed medical events are not performed and to ensure that performed events are documented. For years the standard for identifying prescribed events and for determining if an event has been performed has been to provide a clip board which is hooked to a patients bed. Typically the board is updated manually by a physician each time an event is performed. Prior to performing any medical event, a physician examines the board to make sure that the event was prescribed and to identify prescribed treatment time. If the event is required at the present time, the physician performs the event and updates the board to reflect performance.
Unfortunately, despite regulations, sometimes a physician forgets to examine a board prior to performing event. Similarly, sometimes a physician forgets to update a board after performing an event or, may make a mistake in updating the board. In addition, even if updated correctly, a physician on a later shift may not be able to decipher information on a board and may therefore erroneously reperform an event or fail to perform a prescribed event. Moreover, there is always the possibility that two boards may accidentally be interchanged such that an event could be performed on the wrong patient.
One other problem with existing methods for diagnosis, prescription, performance of prescribed treatment and treatment tracking is that diagnosis and prescription may often be modified during a patient's stay at a facility and the modification might not always take into account a patient's complete medical history. For example, a patient might be admitted to a hospital for a five day period. During the period, the patient might initially be diagnosed with sickness ZZZ for which drug C is typically prescribed. However, because of allergies which prevent the use of drug C, drugs A and B might be administered and recorded on the board without identifying the allergy. On the third day the diagnosed sickness might be changed from ZZZ to YYY and a procedure P might be performed to treat sickness YYY wherein procedure P is typically followed up by administration of drug C to counteract side effects of treatment P. Assuming the allergy is not indicated on the board, a nurse might automatically administer drug C which would cause the patient to have an allergic reaction. While this example is simplistic, it is helpful to illustrate the type of problem which can result from present manual diagnosis, prescription, administration and tracking procedures. This problem is exacerbated during longer hospitalization periods and as different treatments are prescribed.
To ensure that medical events are not prescribed which might adversely interact with factors in a patient's medical history (e.g. allergies, additions, etc.), it is policy at most medical facilities that only a single primary physician who is most knowledgeable about the patient's medical history prescribe medical events during the patient's stay at the facility. Thus, in the example above, presumably the physician who initially prescribed drugs A and B would remember the patient's allergy to drug C and would not prescribe drug C after procedure P.
While this "primary physician" policy is helpful, this policy can lead to some undesirable situations. For example, if a new symptom or condition occurs and the primary physician is unavailable, one of two choices has to be made. First, an attending physician may elect to wait until the primary physician can be contacted to determine how to respond to the new condition or symptom. Clearly this choice causes delay in treatment and may exacerbate the patient's condition. In addition, assuming the primary physician is located, the primary physician might not remember all aspects of the patient's medical history which may have some bearing on which medical event to prescribe to treat the symptom or condition.
Second, the attending physician may use what little medical history information is available on the patient's board to prescribe a medical event to treat the new condition or symptom. Neither of these two options is optimal as each option has several obvious pitfalls.
Thus, it would be advantageous to have a system which could automatically double check patient diagnosis and event prescription as a function of medical history, automatically track event performance, identify unprescribed events prior to performance and stop performance of unprescribed events. In addition, it would be advantageous if, when a diagnosis or prescription is seemingly incorrect, an apparatus could indicate an incorrect diagnosis or prescription.